Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Medicare Open Enrollment with Joe Seely.

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Thanks for listening today!  We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsors Mercy Medical Center, Studio Arts & Glass . As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.

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Transcript from Show:

Q:  You have a lot of experience in the healthcare industry, can you briefly list your background?

A:  Well, I spent 35 years with a national wholesaler, the largest in the United States and the last ten years of that was in Operations for a nation-wide, 47-hundred store virtual chain.  My Operations duties included developing staff training for the 47-hundred stores, developing operational support programs, tracking growth along with other administrative duties.  The biggest challenges there was continually adapting to industry changes.  I retired from there in 2016.

Then, I went to work in my second career at Medicine Center Pharmacy…again in Operations and I faced some of the same challenges all over again.  The only difference was that it was much more ‘hands-on’ and much more rewarding.  I got a chance to see if everything I learned in the previous 35 years and taught to our member stores actually made a difference and were worthwhile.  I also got involved in many different and ‘new-to-me’ responsibilities.  The three years here have been as rewarding as the previous 35.  I got to be involved in so many different things.

One of the most rewarding jobs was sitting down last year at a table in each of our stores and assisting about 350 of our senior customers in selecting the best Medicare plan for them based on their specific needs.  I became part of the great customer service that our staff, our pharmacists and technicians bring to the table every day.

Q:  So you’re our Medicare Enrollment Specialist?

A:  No, I am not a Medicare Enrollment Specialist, there really isn’t such an animal with a formal credentialing…but Medicare rules are very specific.  All I can do is present the information to the patient honestly and inclusive of all of the plans that are available to them.  I can’t hide any plans or misrepresent plans.  I just present the facts, an estimate of Out-of-Pocket costs for the patient based on the current year and instruct the customer how to proceed with his or her choice.  There are so many terms, choices, a step by step order of events…it can be very confusing to so many people.

At Medicine Center Pharmacy, we purchase access to a very sophisticated and all-inclusive software system that loads in all of the Medicare Advantage and Medicare D plans available according to any specific zip code.  It factors in their specific prescription usages and their specific needs then sorts those plans for the customer.  I learned enough about the system to use it pretty well and then last year, I was lucky enough to have that sit-down session with some of our customers.

Q:  This sounds like it is going to be confusing.  Maybe we should start at the beginning.  Let’s say I am 64 and will soon be retiring and eligible for Medicare.  What can I expect?

A:  Well for one thing, a lot of junk mail and two or three marketing robo-calls every day!  Seriously, it is overwhelming!  And so misleading!  Every caller tells you they are from Medicare and going to walk you through enrollment…They are not from Medicare.  Medicare doesn’t call.  They are from any of the several insurance companies that want to help you sign up for their company’s insurance.  You need to do this yourself or talk to someone you trust that will help you through this process…not a random caller on the phone.

Medicare starts at age 65 for most people; it can start earlier for others that suffer from specific disabilities or other special situations, but that isn’t the usual case.  To qualify for Medicare, you must be a US Citizen or a legal resident that has lived in the United States for 5 consecutive years.  At your 65th birthday, you are in what is called the Initial Enrollment Period.

If you are already receiving Social Security, perhaps for a disability or perhaps you just decided to take Social Security early, perhaps at age 62, the process is automatic.  Three months before your 65th birthday, you will just receive your Medicare card in the mail.  Sort of an early, ‘Happy Birthday’ present.

If you are not receiving Social Security, you need to initiate the process.

You can enroll in Medicare 3 months before your birthday month…so if your birthday is in April, then on January 1st, that is January, February, March…1-2-3, 3 months before your April birthday month.  The Initial Enrollment Period then goes for 3 months after your birthday month.  So your April birthday means that May, June and July are also part of the enrollment period.  The Initial Enrollment Period or window is seven months.

The easiest enrollment is done through the Social Security website, or you can do it via telephone, or in person at the nearest Social Security Office.  The process from initiating enrollment to receiving a Medicare card and number back in the mail takes only about 3 weeks.

Q:  So everyone has to enroll in Medicare?  And do you have to do it at age 65?

A:  No, I guess no is the answer to both questions.  This is America, a free country so ‘having to’ is subjective.  However, if you do not enroll in the Initial Enrollment Period, that seven-month enrollment window around your 65th birthday, there will be monetary penalties to pay when enrolling later.  Unless there are specific circumstances, when you do decide to enroll, the penalties will be a percentage of the costs increased by every month you delayed.  So you can understand that you need to get this done.

Some of the Special Circumstances for not enrolling may include that you are still working and your employer has you covered in a valid health care plan and you don’t need Medicare. Or that you have own coverage on the open market…the important thing is that you have health coverage and that is what delayed you from enrolling in a timely manner.

If you don’t enroll in the Initial Enrollment Period, there are two other chances to enroll.  There is the ‘General Enrollment Period’ which is every year from January 1st to March 31st.  Remember if you wait and enroll then, there may be that monetary penalty to pay for delaying.

There is also the ‘Special Enrollment Period’.  There are a few reasons you may qualify for this, such as you retire and lose your health coverage after you are 65, or you were enrolled in one plan already but moved out of your plan’s service area.  There are some chronic health conditions that qualify a patient for the Special Enrollment Period or enrollment into a State Medicaid program.  There typically is no penalty for enrollment if you qualify for the Special Enrollment period.

Q:  So you have your card, you have your number.  What does that cover?

A:  Your card comes in the mail within two or three weeks after applying, that is provided the application is accepted.  If there is missing data, there may be a couple of phone calls to make…but there should be little standing in the way of getting this done.  Your card comes with your 16-digit Medicare number and the date of enrolling in Medicare Part A and Medicare Part B.

Medicare Part A will cover your hospital stays and in-patient care while you are in the hospital.  Medicare Part B will cover your doctor visits and outpatient care.

Q:  Is there a cost for Part A and B?

A:  If you or your spouse has worked and paid taxes to Medicare for more than 10 years, there is no fee for Medicare Part A, the hospital and inpatient part of Medicare.  If you don’t meet that 10-year requirement, there can be monthly fees assessed.  The fees are based on how much you did work and pay Medicare taxes.

There is a standard fee for Medicare Part B, the doctor and out-patient part of Medicare.  The standard monthly fee for Part B in 2020 is about $144.  This was a $9 increase from 2019.  It has not been shared what the fee will be next year, in 2021.  The fee can be higher if you have a higher income.

Q:  So that’s all you need?  Medicare A & B?

A:  No, that covers your hospital and doctor costs, but there is so much more.  A very large part of your Health Needs include prescriptions and neither Part A or Part B have you covered on that.  Prescriptions are covered by Medicare Part D, and that is an annual enrollment.  After you have received your Medicare card in the mail, you need to pick out a Medicare Part D plan that covers prescriptions and it is very wise to pick out a Part C plan.  Unlike Part A and Part B which are one-and-done, Part C and Part D have an initial enrollment period and then are renewed or reviewed annually, every October 15th to December 7th.

Q:  Part C?  Part C?  No fair.  You haven’t mentioned Part C yet.

A:  I didn’t mention Supplemental Programs either.

Part C is easy.  Part C is bundled.  Part C wraps Part A, the hospital with Part B, the doctor and most of the time, adds in Part D, the prescriptions into one program.  Depending on the Part C program you chose, there might be limits on networks and accessibilities.  But the limits result in cost control for the cardholder and usually for the network.  It also puts caps on the annual cost to the patient.  The cardholder’s Maximum Out-Of-Pocket costs are capped at a specific dollar amount, depending on the plan that is chosen.

Q:  Explain the Maximum Out-Of-Pocket costs.

A:  Let’s say you have a Medicare card with A and B coverage and to cover your drugs you just have a Medicare D coverage.  You can take that Medicare card anywhere that accepts Medicare and Medicare will pay a percentage of the doctor or hospital bill.  You will be billed for the residual.  Get a thousand dollar doctor bill, you pay your 20% and Medicare pays the rest.  What costs $1,000?  Getting your tonsils out maybe?  Your part of the bill or your responsibility to pay will be $200.  A trip to the emergency room for a broken arm?  Maybe that will only cost $1,000.  What about something more serious…heart surgery for instance?  How much can that run…$100,000?  $150,000?  More?  You are still responsible for that same percentage of the bill.  There is no cap on your responsibility.  That is why you should have coverage under Medicare C, or what is known as a Medicare Advantage plan.  This protects you from catastrophic events raiding your savings.  Most every Advantage Plan or Part C plan includes coverage for Part D.

Supplemental programs are another form of Medicare Advantage plans.  They are often part of a retirement pension or can be purchased individually.  They rarely contain prescription coverage, or Medicare D coverage and the cardholder is asked to enroll for Medicare D to cover their prescriptions on their own.  Supplemental plans usually have much higher monthly premiums than Advantage plans, but the Out-Of-Pocket costs are capped at a much lower amounts.

Another big advantage to Medicare Supplemental plans or Medicare Advantage plans are that more areas of health care are covered.  We stated that Medicare A covers the hospital and in-patient services, Part B covers physician and out-patient services and Part D covers prescriptions.  We left out Eye Care, Dental Care, and hearing aids, all of which can cost quite a bit.  This is what is nice about Advantage Plans and Supplemental plans is that often, these other health care items are provided some coverage and Out-Of-Pocket costs are reduced for the cardholder.

Q:  Do I have to have Medicare D coverage?  What if I don’t take any prescriptions and want to wait until later. 

A:  The same penalties for delaying enrollment that applied to Medicare A and B apply to Medicare D.  For every month you didn’t sign up, the premium will be raised by a percentage. 

Paul Q:  What about these discount cards?  Like The Martin Sheen card…Single Care or the Good Rx Card.  Do these count as Medicare D coverage?

A:  No, most definitely not.  I know seniors that believe they do count though, sad to say.  And now, they realizing that they’ve made a mistake they face a penalty to enroll in a Medicare D coverage.  Brad can probably answer this better than I can as to what these cards are good for.

 •   Can be Ok for cheap, maintenance generics

•   Similar to our own Generic Wellness program

•   Provides legal access to discounted prescriptions or cash prices

•   Bypasses more expensive third party copays or deductibles

•   Horrible for brand pricing as it provides for no cap in spending

•   Imagine a catastrophic disease state trying to cover prescription costs with a card that doesn’t have an Out-Of-Pocket cap for customers

•   Cancer - Specialty Drugs

•   Diabetes

Q:  Ok, so we need to have Medicare C coverage either through an Advantage plan or a Supplemental plan and we need to have Medicare D coverage for drugs.  But why do we have to go through this enrollment period again, every year after year after year?

A:  Things change.  Everything changes.  Your health needs change.  Your prescription needs change.  The health care plans themselves can change.  Your address may change and you may be in a regional plan that isn’t available in your new address.  As we grow older, new health issues may challenge us.  Any of these changes or new challenges may determine that the plan you chose last year, two years ago or upon initially selecting a plan is not the right plan for you anymore.  CMS, or Medicare recognized this when adding Part D in 2006.  One study done by one of the plans was reported in Drug Store News that as many as 9 out of 10 Americans are not in the plan best suited for their specific needs.

There are also incentives for plans to get better.  Plans are rated from one-star to five-stars.  The ratings are based on many things, customer service is just a part of the rating.  If you signed up for a plan and their ratings fell to just one or two stars…wouldn’t you welcome the chance to switch to a different, higher rated plan?  A plan that is better in access and customer service?  Of course you would.  No one likes not being treated well, not being treated as a valued customer.

So sitting down and reviewing the options available to you every year during the enrollment period is the smart thing to do.

Q:  Nine out of ten?  Is that right?  When you sat down with our customers last year, did it seem like only one out of ten was in the right plan?  How many did you say, 350 customers?

A:  Unfortunately, I didn’t keep track of the interviews.  The estimate was that we saw between 350 and 400 customers during the 7-week enrollment period.  But to answer your question…yeah…surprisingly so.  There were very few customers that I put into the database, added their prescription needs, their primary physician, hit the magic ‘sort’ button and got, “Voila, You’re in the perfect plan!”

Q:  If they weren’t in the ‘perfect plan’. Were you able to save them money and change them to ‘the perfect plan’?

A:  I was able to share the analysis with them.  Remember, legally I am not there to change them from one plan to another.  Legally, all we can do is provide a fair and honest representation of their spending expectations forecast for the next year.  It is a forecast based on this year’s usage and needs.  We are not alone in this, anyone offering to do an analysis is bound by this same rule.  We provided the printed analysis, and something not many others do, we provided access to the same database we were looking at so they could verify the information with another source.

Q:  Did customers like that?

A:  Oh yes, most definitely.  Many took the access and stated that they would look at it at home, or have their son or daughter look at it, someone they trusted without question or someone that already helped them with making decisions.  The access we give to the database also has quick, online links to enroll and access to those giant manuals that spell out everything the plan covers.  I got the sense that there was gratitude for the access and actually heard back from customers later about how nice this made the enrollment process.

Q:  So did we see a lot of people changing last year?

A:  Big sigh here.  You know how many people are…there seems to be such a resistance to change.  I remember one customer that decided to change from her current plan because a different plan was projected to save her $18 for the next year.  She said something about, “$18 dollars is a nice lunch out…better me than the insurance company!”  I applauded her.  But I also had others that would have saved over $1,000 by switching and still refused because, “That is the company I have always had and they have always done me right.”   There were so many reasons given for not changing.

•   The loyalty as I mentioned

•   Some stated that the phone call to make seemed like too much trouble

•   There was the fear that their doctor or their hospital might not be accepted on the new plan (another phone call)

•   There was always the story, “I had my gallbladder out 10 years ago and do you know what the bill was to me?  Nuthin, absolutely nuthin.”  In the meantime I see the monthly premium is substantial, actually quite substantial.

Mostly people just resist change.  I guess that is in our nature…we become complacent with what we have and don’t accept that it could be better.  I still applaud the lady that changed for her $18 and her nice lunch out.  She gets to go to her same physician she always went to, use the same hospital that was always available for her and the same pharmacy for her prescriptions.  She just writes a check to a different insurance company every month and I hope she actually had that very nice lunch.

Q: Cute story.  I hope she had that nice lunch also.  What should our customers consider when making their choices?

A:  Many things go into the selection.  And there are so many different plans available. 

•   First of all, are they looking for only Medicare Part D coverage or do they need to consider a Medicare Advantage plan?  If they have Supplemental plan or a retirement plan that includes health care coverage with a cap on out-of-pocket costs, then a Medicare Part D, prescription coverage is that is needed.  Typically, in fact always, there are monthly premiums associated with this coverage unless you qualify for dual coverage.  Dual coverage is where you are eligible for both Medicare and Medicaid.  The higher the monthly premium, the lower the co-pays. 

•   There are many different plans, you need to sort through them to find the best fit for you

•   Some require mail-order or limit which pharmacy you can go to.  They sort by ‘preferred’ network pharmacies or out-of network or ‘non-preferred’ pharmacies and may charge different co-pays depending on your pharmacy choice.

•   Some limit what specific prescription items they may cover and may force you as a patient to change.  A good example of this is Proventil vs Ventolin inhalers…both the same inhaler, both virtually the same medicine yet insurance companies seem to choose which one they will cover and which one they won’t.

•   Different plans have different deductibles to meet…and not every prescription counts towards the deductible.  For instance, on several plans, Eliquis, a popular heart medication for patients with AFib, counts as a prescription that is part of your deductible.  That first fill in January may cost you several hundred dollars.  On other plans, Eliquis is accepted as a perfectly usual item and does not count towards your deductible.

•   If you are not capped by a supplemental plan, you want to look for an Advantage Plan.  Like Part D plans, there are many different plans, you need to sort through them to find the best fit for you.

•   Most State Medicaid patients will be forced into a limited number of plans and will not have as wide a selection to choose from

•   There are both regional plans and national plans available.  Someone that winters in the south three months a year may want to be sure to select a national plan so that health care visits when away from home are not labeled ‘out of network’.  This is true for anyone that travels extensively .

•   Advantage plans can cover dental, eye and hearing needs.  If your hearing is perfect, or you have no teeth you might choose a plan that does not include that portion for a lower monthly premium.  Advantage plans can also offer memberships to gyms or exercise facilities, sort of a healthy life-style incentive.

•   There are those Advantage plans that have no monthly premium to pay but perhaps have higher deductibles or higher out-of-pocket costs.  Others have a substantial monthly premium but lower deductibles and much lower cap on the total out-of pocket costs.

•   There are HMO’s, (Health Maintenance Organization) defined networks of which physician or hospital is considered ‘in-network’. 

•   Pros - Lowest costs

•   Cons - Less choice and Specialty Care is harder to get

•   There are PPO’s (Preferred Provider Organization) which allow the patient go anywhere that accepts that Advantage card.

•   Pros - Free choice of physician and services

•   Cons - Out of network choices will result in much higher copays

•   There are POS (Point Of Service) plans…sort of a marriage of the other two plans.

•   Pros - maximum freedom. Go anywhere and you don’t need a referral from your Primary Care Physician.

•   Cons - Higher co-pays and deductibles for non-network services.

Really, you need to look at your prescription usage, just like in Part D, and your expected health care needs for the next year.  It is very important to plan ahead.  There were a few cases in last year’s patient interviews that played into the selection.  One customer had just been diagnosed with Diabetes; she knew her health needs for the next year were going to change dramatically.  Another shared with me her diagnosis for Stage 4 lung cancer and wanted to pick a plan based on that.

Q:  Joe sat in each of our stores last year conducting these patient interviews and supplying the choices and analysis’s to our customers.  He will be bouncing around to all of our stores the next few weeks doing the same this year.  Do you know your schedule yet?

A:  Yes, the enrollment period actually opened up yesterday, on the 15th.  I am going to start next week, Monday through Friday in our Louisville store. 

The week of October 26th, I will be in our Minerva store, then on November 2nd I will be in our Canton store.  The week of November 9th, I will be in our New Philadelphia store and then back to Louisville for November 16th.  That takes us into Thanksgiving week in which we will not be actually in any of the stores. 

The week after Thanksgiving is the last week of enrollment.  I believe we will be doing ‘last minute’ interviews by phone only.

We will of course be taking the proper precautions due to the pandemic, by sanitizing the area of the interview after each patient, and keep social distancing in mind.

Customers interested should call the stores and schedule an interview.  If those times are not or do not work for your schedule, we have people in the store that are trained and can assist.

Q:  How long does this process take?

A:  Good question, I have no good answer.  Some of the interviews last year were done in the course of five minutes, there were others that took 20 minutes to a half hour.  We tried to schedule them and for the most part, customers didn’t have to wait long.

Q:  Should customers bring anything to the interview.

A:  Yes, their current health care card and if they are not Medicine Center customers, a list of prescriptions.  If they are Medicine Center customers, we should be able to pull their prescription profile up from our history.  But the insurance card is important.  It shows us exactly what their current plan is.

Q:  Thanks Joe.  Any final thoughts?

A:  No, well yes, I do have a couple. 

I just wanted to re-state how rewarding I found this to be last year.  Meeting our customers, assisting them with their selections…I have to be honest.  It made me wonder if I wasted away my career in Operations.  Customers and having contact with them was truly wonderful and personally rewarding.  Brad, Paul, Nancy back at the office…Thanks so much for allowing me to do this again this year. 

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss common eye conditions with Dr. Brian Mathie, Optometrist from Roholt Vision Institute.

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Thanks for listening today!  We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsors Mercy Medical Center, Studio Arts & Glass . As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.

Podcast:

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss COVID19 Updates with Dr. Michael Linz, Chief of Hospital Medicine at Mercy Medical Center. Our topic will be a local update on Covid 19 and an update on current events at Mercy Medical Center

Thanks for listening today!  We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsors Mercy Medical Center, Studio Arts & Glass . As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss tips for staying healthy.

Good morning and welcome to Health Matters with the Medicine Center Pharmacy. I’m your pharmacist, Paul White. We’re glad you joined us. Before we begin, I would like to thank our sponsors, Mercy Medical Center and Studio Arts & Glass, We continue our shows from our administrative offices and wish our friends at WHBC and our listening audience continued good health. In the studio with me is Brad White, a compounding pharmacist and Vice President of Medicine Center Pharmacy.

 Brad:    Most of the time we think about being well as avoiding colds and the flu so we can go about our normal lives.  At Medicine Center Pharmacy our focus is always on our patients and their wellness.  We will help you develop a plan to stay well; especially during this pandemic.  Today we want to share some tips to help all of you stay healthy to live your best life and accomplish all those things that bring you joy.

 We’d like to remind our listeners that today’s program is also available on our podcast which can be downloaded from the app store on your mobile phone. Look for Health Matters with the Medicine Center Pharmacy and you can listen to any of our programs, anytime.

Paul:  Friends, I would like to start by sharing some exciting news.  Our Medicine Center Pharmacy was voted Best Pharmacy for the third consecutive year by readers of the Canton Repository and we were also nominated for Good Neighbor’s Pharmacy of the Year.  We are proud to be your pharmacy and thankful to all of those who voted for us.  Thank you for your continued support.                     

Paul:  As Brad mentioned earlier, Staying Well is a priority and like all priorities,  its requires a plan or a strategy to successfully fulfill that priority.  This morning we would like to share our Top 10 Tips for staying well.                   

Tip #1 – Stay immunized! 

Making sure you have you are up to date on your vaccinations is an important health foundation. Get your annual flu vaccine today and talk with our pharmacists about other vaccine needs like pneumonia, shingles, hepatitis A, Hepatitis B, and TDAP. For more information about our vaccine services visit our vaccination page.

Tip #2 – know your numbers!

The COVID-19 Pandemic has made it challenging for patients to maintain their regularly scheduled medical visits and get routine lab work. The Medicine Center Pharmacy has a number of point of care tests available in the pharmacy to help you know your numbers. Learn more about common health screenings like Lipid Profile Test, A1C Test, Thyroid TSH, Vitamin D Test, or check out our lab screening scheduling page to make an appointment.

Tip #3 – Support Your Immune System!

Give yourself the added advantage of supporting your immune system with a healthy diet and supplements to boost your immune system. A Quality Multivitamin, Vitamin D Supplement, and Immune Boosting supplements like Immuno Power are great ways to give yourself an advantage.

Tip #4 Limit Exposure – or as we hear on the news, limit contacts!

Being conscious of what you touch, how often you wash your hands and use hand sanitizer can make a large impact on your health and wellness. Masks have also been shown to reduce the distance that airborne contaminants can travel and thus reduce the risk of infecting others in the immediate area. Take advantage of Medicine Center Pharmacy services like home delivery, curbside service, or drive up windows to minimize your exposure and risk during the pandemic and flu season, and wash those hands!

Tip #5 – Follow the doctor’s directions!

Patients that need to manage multiple medications can have additional challenge of remembering to take their medication on time and worry about missing doses. The Medicine Center Pharmacy can help simplify your medication administration with our special Easy Dose Pack medication packaging. Combine all your medication does into simple to follow baggies that are labeled with the day, date, and time.

Tip #6 – Manage your chronic conditions

Specially trained pharmacists and pharmacy technicians can be your health coach and assist with monthly check ins to make sure you have the correct medications synchronized for pickup on the day you need it. They can even arrange for home delivery.

Tip #7 – Education

Our pharmacy team has special training in a variety of areas including diabetes, vaccinations, custom medication compounding, and bio-identical hormone replacement therapy. If you would like to learn more about the educational programs offered at the Medicine Center Pharmacy, visit our Webinars page for the current schedule of programs.

Tip #8 – Know your Pharmacist!

It is so important to have health care professionals that you trust. Your pharmacist at the Medicine Center can be your partner in good health and the most important thing you can do is to ask questions. Our pharmacists have a wealth of knowledge to share and problem solving skills to help solve your problems. Schedule a private consultation today.

Tip #9 – Make it affordable!

Nothing is more frustrating that finding out a medication is more expensive than you can afford. The Medicine Center Pharmacies have a database of manufacturer coupons that can help offset the burden of expensive prescription medications. We can also work with your prescriber to find cost effective alternatives to expensive brand name medications that may be just as effective at a much lower cost. Check out our Generic Wellness Program today.

Tip #10 Enjoy life!

Make an effort each day to take some pleasure in your surroundings and celebrate the positive. Whether it be to listen to your favorite music, take a walk around the block enjoying the sunshine, or practicing meditation and yoga for stress relief, make sure you do something for yourself today.

Thanks for listening today!  We’d like to remind our listeners, if you suspect you have a medical issue, please contact your healthcare provider. Thanks to our sponsors Mercy Medical Center, Studio Arts & Glass. As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss women's health care with Dr. Priya Ramaiah, a Gynecologist and Robotic Surgeon at Total Women's Care in Canton, Ohio.

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

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Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss sinusitis with Dr. Aaron Brescia, Board Certified Head and Neck Surgeon from Ohio Head and Neck Surgeons in Canton, Ohio.

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

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Podcast:

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss how the coronavirus impacts returning to school with Health Commissioner VIckie Ionno, RN, from New Philadelphia City Health Department. 

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

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Podcast:

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Chronic Pelvic Pain with Maurice Chung, M.D., urogynecologist and director of the Mercy Center for Endometriosis, Pelvic Pain & Urogynecology will be on News-Talk 1480 WHBC's Health Matters radio program.

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

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Christopher Fogarty, MSN, APRN, PMHNP-BC, psychiatric/mental health nurse practitioner for Mercy Medical Center will be on News-Talk 1480 WHBC'’s Health Matters radio program this Friday (July 31).

Christopher will discuss the stigma attached to mental health issues and will give listeners advice on ways to cope with the anxiety and stress brought on by COVID-19.

YOU ARE NOT ALONE.  These are powerful words.  It’s important to measure how common mental illness is, so we can understand its physical, social and financial impact — and so we can show that no one is alone.

1 in 5 U.S. adults experience mental illness each year
1 in 25 U.S. adults experience serious mental illness each year
1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
Suicide is the 2nd leading cause of death among people aged 10-34

Most people who experience mental health problems recover fully, or can live with and manage them, especially if they get help early on.

But even though so many people are affected, there is a strong social stigma attached to mental ill health, and people with mental health problems can experience discrimination in all aspects of their lives.

In this podcast we will talk with Chris about mental health initiatives in our community and reducing the stigma attached to mental health conditions.

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

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Health Matters is hosted by Pharmacists Paul White and Brad White from the  Medicine Center Pharmacy, the program will runs live from 9:05am - 10am each Friday. .

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Plastic Surgery and the physician assistant role with Shannon Urena, PA-C from Aultman Medical Group.

This episode is sponsored by Studio Arts and Glass.

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Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Orthopedics and Sports Medicine with Dr. Michael Necci from Aultman Medical Group and we will discuss. 

This episode is sponsored by Studio Arts and Glass.

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Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss the current state of COVID-19 and Contact Tracing with Vickie Ionno, RN, Health Commissioner for the City of New Philadelphia City Health Department. 

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

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The Medicine Center Pharmacies in Stark County are pleased to be a resource for our community. Starting on Monday June 15th you will be able to pick up a Kids CARE Kit with fun resources and activities for children from birth to age 5.

The kit’s contains fun activities, tips, tools, and resources support learning as we safely start reopening Ohio.

There are 300 kits available for Stark County families Get your Great Start for Great Futures Kids CARE kit today!

Get your Great Start for Great Futures Kids CARE kit Starting June 15th, 2020 at the locations below:

Pick-up Locations:

Starting Monday June 15th:

Daily from 9:30 am to 6:00 pm until supplies last

Medicine Center Pharmacy, 2526 West Tuscarawas in Canton

Daily from 9:30 am to 6:00 pm until supplies last

Medicine Center Pharmacy, 700 West Main Street in Louisville

Daily from 9:30 am to 6:00 pm until supplies last

Medicine Center Pharmacy, 251 East Street in Minerva

Thursday, June 18 from 11:00 am to 1:00 pm: Southeast Head Start, 1400 Sherrick Rd. in Canton

Friday, June 19 from 10:00 am to 1:00 pm: William Malloy, 1134 Walnut Ave. in Massillon

Friday, June 19 from noon to 2:00 pm Stark Main Library, 715 Market Ave. N in Canton

Great Start for Great Futures thanks the following donors: Aultman Hospital, Canton Health Department,

Child & Adolescent Behavioral Health, Early Childhood Resource Center, Help Me Grow, Medicine Center

Pharmacy, PNC Bank, Pregnancy Choices, Pro Football Hall of Fame, Stark Community Action Agency, Stark

County Educational Service Center, Stark County Fatherhood Coalition, Stark County Job and Family Services,

Stark Education Partnership, Stark Fresh, Stark Library, Stark Mental Health and Addiction Recovery, State

Support Team Region 9, and our community!

Learn More About Great Start for Great Futures from Health Matters Podcasts:

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Cataract Awareness Month with Dr. Brian Mathie from Roholt Vision Institute Vision Institute.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

Dr. Mathie discusses how many patients are affected by cataract, what to expect from cataract surgery, and the cutting edge technology that Roholt Vision Institute uses to provide care for their patients.

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

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Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss visits with Barbara Frustaci, BSN, RN, Administrative Director Mercy Medical Center Canton Ohio 

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

5/15/2020 Show Notes 

Good morning and welcome to Health Matters with the Medicine Center Pharmacy. I’m your pharmacist, Paul White. We’re glad you joined us. Before we begin, I would like to thank our sponsors, Mercy Medical Center and Studio Arts & Glass, We continue our shows from our administrative offices and wish our friends at WHBC and our listening audience continued good health. Our guest today is Barbara Frustaci, BSN, RN and Administrative Director of Mercy Offsite and Rehabilitation Services. Barbara, welcome back to the show. Thanks for joining us, we are looking forward to talking with you today.

Barbara replies:

Brad:   Like so many aspects of our lives, covid19 has changed everything; especially in the health care community.  Today we will talk with Barbara about the importance of resuming health and wellness physician visits, the safety of our hospitals and moving forward with elective procedures and the resumption of scheduling wellness visits.

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Paul:  While it seems like we have been living under the cloud of this pandemic forever, the reality is it has been about 8 weeks and in that time everything has changed.  Like our pharmacies, Mercy Medical Center’s priority is the health of their patients.  The first step in moving forward is having confidence in the safety of our facilities.  Can you tell us what Mercy Medical Center is doing to keep their facilities safe for patients?

Barbara replies:

Of course, Paul! Our patients can be assured that our main hospital as well as our 10 Health Centers and physician offices are following enhanced cleaning and sanitizing processes in accordance with CDC guidelines. Our waiting room seating at all of our facilities has been rearranged to ensure proper social distancing. We ask that ALL patients wear a face covering or mask during their visit. We also ask that all patients come to their visit or appointment, alone, if possible.  Hand sanitizer is conveniently located for all of our patients to use at any time. Rest assured our employees are practicing proper hand hygiene and are wearing masks to protect our patients and themselves. We always want to remind our patients that proper hand hygiene is critical in order to stop the spread of infection. Also, at our main hospital campus, all patients are screened and temperatures are taken before being allowed into our hospital in an effort to protect our patients and employees. Our patients’ health and safety continues to be our #1 priority as we navigate this pandemic.

Paul:  I understand elective procedures have resumed.  How are procedures prioritized?

Barbara replies:

Yes, Mercy Medical Center has reopened all physician practices and is now performing diagnostic testing not requiring an overnight stay, these include: mammography, pulmonary function testing, sleep studies, therapy services, including physician, occupational, speech therapies and lung screenings. Our surgical teams reviewing surgical cases that have been cancelled and will be prioritizing and rescheduling them in the coming weeks. So, any patients who previously had surgery scheduled then cancelled due to COVID-19, they will be hearing from our team in the next few weeks. Our team will make sure that our previously scheduled surgeries will be handled before adding on new diagnostic and surgical procedures. 

Paul:  What should patients and their families know before coming to a Mercy site for a procedure?

Barbara replies:

That’s a great question, Paul. What our patients and their families need to know before coming to any of our facilities is:

1.    We request that the patient come inside the facility alone, if possible.

2.    We request that the patient has a face covering or face mask already on when entering the Mercy facility

3.    When you enter a Mercy facility, be prepared to be screened and have your temperature taken

4.    If you have COVID-19 symptoms or think you may have been exposed to COVID-19, do NOT come to your procedure or appointment. We ask that you contact your healthcare provider for further direction. If you have emergency COVID-19 warning signs, including trouble breathing, seek medical attention right away. Call 911 or call your nearest emergency facility.

Brad:  The media has emphasized the need for families to social distance while their loved one is being treated or having surgery.  This is a significant concern for many listeners.  How does Mercy handle these situations and keep family members informed?

Barbara replies:

This is correct, Brad, right now Mercy Medical Center, along with all of the local hospitals, have a no visitation policy for safety and protection of our patients and employees. We encourage patients and their families to stay connected virtually, via cell phones, hospital telephones, tablets or computers 24 hours a day. We understand that this is very difficult for our patients and their families and friends. Our Mercy healthcare providers are so kind and understanding, they are helping some of the patients stay connected with family and friends by assisting the patient with Facetime, Skype, etc. We know that connecting with family and friends is so important to the healing process, and our employees want to make that happen in every way possible while adhering to social distancing standards.

Brad:  It seems as though Covid19 has increased awareness and an almost urgent need to utilize Telemedicine.  Can you explain what Telemedicine means to a patient?

 Barbara replies:

Telemedicine allows patients and healthcare providers to communicate via video, phone, or email for diagnosis, treatment, and general care. It allows patients to have virtual appointments with their healthcare providers from the comfort of their own homes. Our Mercy Primary Care Physicians actually have their own telemedicine service, Teladoc, so that they can still hold virtual appointments to treat and diagnose while maintaining social distancing.                    

Brad:  What conditions or symptoms are recommended as being treatable for Telemedicine? 

Barbara replies:

Telemedicine programs like Mercy’s Teladoc can be used for minor health issues that don't require lab tests or imaging to diagnose. Allergies, coughs, colds, flu, infections, insect bites, sprains, and gastrointestinal symptoms can all be evaluated virtually. Of course, for emergency or life-threatening situations, call 911 immediately or go to the nearest emergency facility.

Brad:  Who staffs Telemedicine and how safe is it?

Barbara replies:

Mercy physicians who utilize the Teladoc technologies with their patients, the service is staffed by our physician office employees who call the patient a few minutes for their scheduled appointment to get them registered before their virtual visit with their healthcare provider. With telehealth technologies, patient adherence to care increases, access to care is improved, providers can network with each other, and the safety of patients can be monitored more closely in homes and alternative living facilities. 

Brad:  Does Telemedicine replace our family doctor, or do they communicate and share patient history and other information?

Barbara replies:

Brad, The Teladoc telemedicine program that Mercy utilizes is an actual appointment with your normal healthcare provider, so, no, they do not replace your family doctor, it is simply a more convenient, safer form of appointment with your already established provider. 

Paul:  Do most insurances cover Telemedicine?

Barbara replies:

Telemedicine services through Mercy incur the typical co-pay, but, depends on your insurance plan.

Paul:  How does Telemedicine improve patient outcomes?

 Barbara replies:

Since patients are visiting virtually, it is very convenient – it removed hurdles such as no transportation, or difficulty in transportation to physical limitations. By removing those barriers, it ensured that the patients make and keep their appointments. Also, since the patient is staying at home for the appointment, they are practicing social distancing and staying safe and healthy at home.

Brad:  How is Telemedicine good for our community?

Barbara replies:

During this current pandemic, telemedicine has allowed our communities to still seek medical attention for non covid-19 – related illnesses and injuries, while still practicing social distancing, and allowing patients to stay safe and healthy at home.

Paul:  For the past 8 weeks almost, everything has stopped.  Speech therapy, occupational therapy, physical therapy, etc.  How do we return to normal and what recommendations do you have to help us feel safe and confident as we return to regular appointments?

                           Barbara replies:

It will definitely be a slow, very slow return to every day life. Our community can stay safe and confident by continuing to practice safe social distancing, following all recommended CDC guidelines, practicing good hand hygiene, wearing a face covering or face mask in public areas. We are all in this together. There is no need to panic or be scared. We ask everyone to practice all of the above safe practices while still enjoying all of the wonderful activities and entertainment opportunities as they are allowed to open and be utilized.

Brad:  If listeners are concerned about returning to general health and wellness visits, how would you help them understand the importance of maintaining their health visits?

Barbara replies:

Maintaining health appointments are just as important as ever! In order to protect yourself against COVID-19 and any other illnesses and viruses out there, you need to keep yourself as healthy as possible and your immune system as strong as possible. Telemedicine, as we discussed earlier, is an excellent and convenient way to keep up with your healthcare providers during this time, without leaving the safety of your own home.

Paul:  Should listeners be prioritizing their health and wellness visits – and what guidelines might you offer to help them?

Barbara replies:

Keeping up on your routine health and wellness visits and screenings are important, Paul. We encourage patients to use virtual/telemedicine options with their physicians right now. Our Mercy STATCAREs are also offering telemedicine/virtual appointments as well – so you don’t have to leave the safety of your home, even for a STATCARE visit. Do you what you feel is safe. If you have routine bloodwork, that is not emergent, then hold off until you feel it is safe to go and get it done. And, as always, if you have life-threatening illness or injury, call 9-1-1 or go to the nearest emergency facility. 

Brad:  How are hospitals prioritizing elective surgeries and are they limited to offsite facilities?

Barbara replies:

Many of the diagnostic procedures such as mammography, pulmonary function testing and sleep studies are being done at our main hospital campus as well as select off-site facility. Our surgical teams reviewing surgical cases that have been cancelled and will be prioritizing and scheduling them in the coming weeks. So, any patients who previously had surgery scheduled then cancelled due to COVID-19, they will be hearing from our team in the next few weeks. Our team will make sure that our previously scheduled surgeries will be handled before adding on new diagnostic and surgical procedures. Surgical procedures are only done at our main hospital campus.

Brad:  Are they limited to same day procedures to minimize overnight stays in the hospital?

Barbara replies:

That is correct, Brad, as of right now we are only doing outpatient surgical procedures that do NOT require an over night stay  to keep patients out of the hospital it at all possible. Since the stay-at-home/stay-safe orders are still in place, the safest place for our patients to be is at home, practicing social distancing. This keep our surgical patients, our inpatients and our employees as safe as possible.

Thank you to our guest, Barbara Frustaci, BSN, RN, Administrative Director of Mercy Offsite Rehabilitation. We would like to remind our listeners, if you suspect you have a medical issue, please contact your health care provider. Thanks to our sponsors, Mercy Medical Center, Studio Arts & Glass. As always, we thank our listeners for joining us on Health Matters with the Medicine Center Pharmacy. Have a healthy week and we’ll see you again next Friday right here on News Talk 1480 WHBC.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Fleas, Ticks and COVID-19 pet concerns with Town & Country Veterinary Clinic’s own Dr. Dale Duerr Join us online at News-Talk 1480 WHBC at 9:10am EST every Friday.

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Naltrexone is commonly known as an opiate antagonist. This means this drug competes for the same receptors in the body as opioids, like oxycodone or morphine. In doing this, naltrexone makes it so opioid drugs do not work like they normally would. Basically, it reverses their effects and eliminates the feelings of well-being . It is very useful in accidental or intentional overdose and short or long term toxicity. However, these effects are only seen at the higher doses of Naltrexone. High doses include anything 50 mg or higher. At lower doses, Naltrexone has many different effects. Low Dose Naltrexone (LDN) is usually 1 to 5 mg, but can vary slightly. It still keeps its opioid blocking effects, but for a temporary effect. It’s main effect is working on the immune system. This gives LDN the capability to work in a lot of different areas including autoimmune diseases like rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and so much more.

Chemical Structure of Naltrexone

There are two different main types of inflammatory bowel disease; ulcerative colitis and crohn’s disease (as pictured below). Crohn’s disease is complex and mysterious because the cause of it is unknown. It’s thought that many things contribute such as environmental, genetic, infectious, immune, and non-immune factors. What we do know is that it has a distinct characteristic of life-long inflammation that comes and goes most commonly in the colon and last parts of the small intestine. Crohn’s disease is not limited to these areas, it may affect the whole digestive tract in one area or many areas at once. Crohn’s disease is most commonly diagnosed in young adults, before age thirty. Common complications can include extensive bowel wall injury, fistulas, narrowed intestinal lumen, small bowel strictures, and nutritional deficiencies. Some common treatments are medicines, bowel rest, and sometimes surgery. No one treatment regimen will work for everyone with crohn’s disease, but the goal is to decrease the inflammation in the intestines, to prevent flare-ups of symptoms, and to keep the disease in remission.

For Crohn’s specifically, the mechanism of LDN ties into the distinct life-long inflammation that comes and goes in the gastrointestinal tract. Toll-like receptors (TLR) are a class of proteins in the body that play a key role when dealing with the immune system. Overactivation of TLRs has been linked to various infectious and inflammatory diseases. LDN has been shown to reduce inflammatory response by controlling these TLRs and their signalling. In addition, LDN increases endogenous endorphin signaling through the whole body by short term opioid-receptor blockade. In other words, endogenous (internal) opioid signalling can mimic the effects of opioids because endorphins can cause an analgesic effect. Further, this can promote healing, inhibit cell growth, and reduce inflammation. LDN may even stimulate the body’s own production of endorphins, even after the LDN is no longer in the system. A recommended dosing pattern for LDN in crohn’s disease starts at 1.5 mg per week and can be increased by 1.5 mg per week up to 4.5 mg until symptoms have been reduced.

LDN is unique in the sense that it is not made by a manufacturer like other traditional prescriptions. It is only made in compounding pharmacies, making the dosage and formulation type unique to each prescription. LDN can be compounded into come in liquid, capsules, sublingual drops, cream or tablets. A LDN prescription will require working with both a physician and pharmacist. In almost every recorded trial where LDN is used for the treatment or improvement of crohn’s symptoms, there was a positive effect on the outcome. It has shown to improve crohn’s disease activity index, remission after failing multiple standard regimens, clinical improvement, and reduction in use of anti-inflammatory medications. It is also important to note that the improvement of these outcomes does not come at a price.

LDN very rarely has been associated with side effects during trials and has been well tolerated. Some of the most common side effects reported with its use in trials for inflammatory bowel disease were vivid dreams, drowsiness or insomnia, and headache. These side effects do not affect the effectiveness of LDN. The LDN Research Trust states that in inflammatory bowel disease,

LDN is expected to be successful 78 - 84% of the time according to patient’s reports. The first time LDN was used for inflammatory bowel disease in clinical trials was published in 2007. This refers to a study that used compounded 4.5 mg capsules of LDN daily for three months in addition to their regular medications. LDN was used to determine if it’s use helped enrolled patient’s symptoms related to crohn’s disease. To assess LDN’s effect on disease activity, patients recorded their symptoms in a Crohn’s symptom diary recording things like frequency of diarrhea, abdominal pain, and general well-being. This was used to calculate a Crohn’s disease activity index (CDAI). The index scores can range from 0 to about 600. A CDAI of less than 150 is a marker of remission of Crohn’s disease and a score of greater than 450 is a marker of severe Crohn's disease. Their study results indicated that out of the seventeen patients enrolled, 89% of the patients had a response to the LDN and 67% achieved remission according to their CDAI score.

More recently, in 2018 another study evaluated LDN in patients both not in remission and not responding to the usual therapy for treatment of inflammatory bowel disease. Including more patients than ever before, this study’s goal was to assess LDN’s effects for inflammatory bowel disease treatment of actual patients rather than theoretically or in the lab. Forty-seven patients with inflammatory bowel disease used 4.5 mg of LDN daily for 12 weeks. Clinical improvement was measured by patient self-assessments and outpatient assessments. Of the enrolled patients, 74.5% achieved a clinical response overall. Of those patients who achieved a clinical response, 25.5% of patients had a response of at least 3 months whereas the rest were seen between four and twelve weeks. The biggest difference between this study and the previous study mentioned is this study takes into account both ulcerative colitis and crohn’s disease. However, the results did not show any significant differences between the two types of inflammatory bowel disease. Overall, all studies have shown LDN in crohn’s disease to help in either remission of symptoms or clinical improvement in a well tolerated manner. More and bigger studies are needed to prove it’s place in practice, but it continues to show benefits as a safe add on treatment for the complicated gastrointestinal disease known as crohn’s disease.

The Medicine Center Pharmacy in New Philadelphia specializes in custom compounded medications in custom dosage forms. The pharmacists are trained experts in low dose naltrexone therapy. LDN therapies can be customized across 23 different dosage forms for 15 different disease state protocols. If you would like to learn more about low dose naltrexone or would like to schedule a phone call or video conference please contact us.

Key Articles

★ LDN Rx Consultants (July 2019). Inflammatory bowel disease (IBD) [PDF

file]. Retrieved from: ldnrx.com.

★ Lie MRKL, Giessen JV, Fuhler GM, et al. Low dose Naltrexone for induction

of remission in inflammatory bowel disease patients. J Transl Med

2018;16(55):1-11.

★ Pradeep Chopra (2014). Mechanism of action of low dose naltrexone (ldn)

[PowerPoint slides]. Pain Management Center, RI. Retrieved from:

https://www.ldnresearchtrust.org/sites/default/files/LDN_Mechanism_Of_

Action_Pradeep_Chopra_MD.pdf .

★ Revia® (naltrexone hydrochloride tablets USP) [package insert]. Pomona,

NY: Duramed Pharmaceuticals, Inc.; issued Oct 2013.

★ Smith JP, Stock H, Bingaman S, et al. Low dose naltrexone therapy

improves active crohn’s disease pilot study. Am J Gastroenterol

2007;102:820-28.

★ Toljan K and Vrooman B. Low-dose naltrexone (ldn)-review of therapeutic

utilization. Med Sci 2018;6(82):1-18.

Low Dose Naltrexone (LDN) is increasingly used by clinicians for management of challenging medical conditions such as chronic pain or autoimmune disorders.  Even though research on LDN as a treatment modality for certain diseases remains sparse, there are several clinical studies conducted to evaluate the effect of LDN for treatment of these conditions and they have shown beneficial effects on symptom improvement.  LDN is known to be extremely safe and well tolerated, especially when compared to the drugs typically used to treat these conditions. That is why LDN is considered as a valuable option for clinicians and is an important focus of ongoing research.

 It has recently been found that the addition of LDN to treatment regimens for mental illness can help reduce symptoms.  However, the evidence showing efficacy of LDN use in treating mental illness is still lacking but the research is ongoing.  I am going to review several clinical trials that focused on LDN and psychological disorders and then discuss the beneficial effects and how LDN can be promising for patients with mental illness.

Naltrexone is a reversible competitive antagonist at the mu and kappa receptors and to a lesser extent is a delta receptor antagonist.  At oral doses of 50–150mg, it can reverse opioid overdoses and treat alcohol addiction.  Paradoxically, LDN enhances the effects of opioid agonists by blocking the opioid receptor transiently which causes a positive feedback mechanism that increases the production of endogenous peptides.  Increased levels of endogenous opioids peptides are known to promote healing, inhibit cell growth, and reduce inflammation.  Naltrexone works by binding to the C-terminal pentapeptide of the scaffolding filamin A with strong affinity. Filamin A is also found on dopaminergic D2 and D3 receptors which might explain the effect of LDN on prevention of desensitization to D2/D3 agonists.  This potential LDN mechanism on dopaminergic receptors led researchers, Bear and Kessler, to propose a study to evaluate for beneficial effects of LDN on restless leg syndrome (RLS)5. The study showed that RLS symptoms had improved with the use of LDN.  RLS is typically treated with D2/D3 agonists such as pramipexole or ropinirole. Thus, the researchers suggested that the LDN use would effective in RLS possibly due to facilitated sensitization of D2/3 agonists.

The pathophysiology of depression is thought to involve abnormal dopaminergic D2 receptor function which is possibly associated with D2 receptor desensitization4.  An observation study has demonstrated that patients had a relapse with depressive symptoms when a D2 antagonist was given following successful treatment with SSRI.  The result was similar in an animal model of depression in which the symptoms were reversed by tricyclic antidepressants4.  Therefore, the prevention of D2 receptor desensitization may be essential to effectively treat depression when combined with antidepressants such as SSRIs or SNRIs.  Antidepressants may foster the sensitization of D2 receptors and LDN may exert antidepressant effects by preventing D2 receptor desensitization and thus enhancing dopaminergic signaling.

In addition, there has been anecdotal evidence in multiple trials showing that LDN has beneficial mood effects in different conditions.  Following the RLS study, a randomized, double blind pilot trial was initiated based on this background information.  The study was conducted to evaluate the hypothesis that patients experiencing depressive breakthroughs would demonstrate greater improvement in their depression when supplementing their current antidepressant regimen with LDN versus placebo, with no significant difference in side effects5. In the study, 12 adults with recurrent major depressive disorder (MDD) on dopaminergic antidepressant regimens (stimulants, dopamine agonists, bupropion, aripiprazole, or sertraline) were randomized to naltrexone 1 mg b.i.d. (n=6) or placebo (n=6) augmentation for 3 weeks. The study found that LDN augmentation reduced the severity of depression symptoms in 12 depressed patients who had relapsed on dopamine-enhancing antidepressants. The key finding of the study is that if a patient has depression and has experienced a relapse while taking a previously effective antidepressant that works primarily by dopaminergic mechanisms, the addition of LDN could potentially reduce the depressive symptoms when combined with the original antidepressant. However, a major limitation with this study is that the patient sample is small.  It may be necessary to reconduct this study with a larger sample size to confirm the significant difference between the LDN and placebo group.  Also, the study included only antidepressants that work by dopaminergic mechanisms.  Thus, additional studies should be conducted to determine how effectively it would work with other types of antidepressants.

A retrospective case study, performed by the Department of Psychiatry at the UCLA Kern Medical Center in California, had investigated the efficacy of LDN on a comorbid depressive disorder6.  In the report, 5 patients received at least one month of LDN, 2 patients had a diagnosis of MDD, and 2 patients had Bipolar Type II and 1 patient had Bipolar Type I.  The results from this study showed that of these patients, 2 patients with fibromyalgia only had minimal improvement, 1 patient with lumbar discopathy had no improvement, and 1 patient with Lupus had much improvement with liquid LDN.  At the conclusion of this case study, 80% of patients experienced some degree of improvement with LDN at week 4.  Another study conducted by a German Research Group in 2015 found that patients with severe trauma-related dissociative disorders had positive effects after treatment with LDN at doses ranging from 2 - 6 mg daily7.  In this study, 11 out of 15 patients reported immediate positive effects and 7 patients described a lasting beneficial effect.  Although it is not known how LDN positively affects patients with depression or posttraumatic psychotic disorders, it seems that LDN has some association with beneficial effects on depressive or psychotic symptoms in those patients. However, these studies remain limited due to their small sample sizes. These studies need to be replicated with a larger patient population to validate the positive efficacy of LDN on those mental health problems.

As mentioned earlier, it is well known that LDN has beneficial effects on chronic pain and autoimmune disorders.  This knowledge led researchers to conduct clinical studies evaluating the effect of LDN on certain medical conditions such as multiple sclerosis (MS), fibromyalgia, or Crohn’s disease1. LDN has been the subject of many debates and despite there being few clinical studies performed, these studies are key clinical trials demonstrating how LDN results in significant improvement of symptoms.

            Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, and mood issues. Thus, patients with fibromyalgia are sometimes treated with antidepressants. There is a single-blind crossover pilot study that investigated the effectiveness of LDN in treating fibromyalgia symptoms8.  The study was conducted based on the hypothesis that LDN may reduce fibromyalgia symptoms by inhibiting the activity of microglia and thus reversing central and peripheral inflammation. In this trial, 10 women with fibromyalgia participated and completed daily reports of symptom severity during baseline (2 weeks), placebo (2 weeks), LDN (8 weeks), and washout phases (2 weeks).  In addition, participants visited the lab every 2 weeks for tests of mechanical, heat, and cold pain sensitivity.  This study results showed that LDN reduced fibromyalgia symptoms in the entire cohort with greater than 30% reduction over placebo.  In addition, participants showed improvement in mechanical and heat pain thresholds during the laboratory visits.  Also, participants reported that side effects including insomnia and vivid dreams were rare, or minor and transient. The study concluded that low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia.   The mood changes in fibromyalgia patients may be associated with the severity of pain that the patients are experiencing.  Therefore, it can be suggested that improvement in pain symptoms may contribute to reduction of depressive symptoms in patients with chronic pain.  In other words, LDN may have beneficial effects on mood disorders by exerting positive effects that lower the severity of pain experienced.

            Prescribers are becoming increasingly interested in LDN use for various medical conditions since it is well tolerated, safe, and inexpensive.  Also, several key clinical trials have shown that LDN may be promising for the management of recurrent or hard to treat mental illnesses, but further research is needed to ensure the efficacy of LDN for those medical conditions.  However, researchers emphasize that LDN should not be used alone for the treatment of mental illnesses, but it can be added to enhance the therapeutic effects of existing regimens.  In conclusion, LDN can be effective in treating mood disorders when combined with current regimens but additional studies with larger sample sizes are needed  to generate more reliable data.

The Medicine Center Pharmacy in New Philadelphia specializes in custom compounded medications in custom dosage forms. The pharmacists are trained experts in low dose naltrexone therapy. LDN therapies can be customized across 23 different dosage forms for 15 different disease state protocols. If you would like to learn more about low dose naltrexone or would like to schedule a phone call or video conference please contact us.

 References

1.     Low Dose Naltrexone. Provider Guide.

2.     Chopra, Pradeep. Mechanism of Action of LDN, Low Dose Naltrexone. Provider Guide.

3.     Wang, H.Y., Frankfurt, M., Burns, L.H., 2008. High-affinity naloxone binding to filamin a prevents mu opioid receptor-gs coupling underlying opioid tolerance and dependence. PloS One 3, e1554.

4.     Willner, P., 2002. Dopamine and depression. In: Di Chiara, G. (Ed.), Handbook of Physiology: Dopamine in the CNS. Springer, Berlin, 387–416.

5.     Mischoulon D, Hylek L, Yeung AS, Clain AJ, Baer L, Cusin C, Ionescu DF, Alpert JE, Soskin DP, Fava M. Randomized, proof-of-concept trial of low dose naltrexone for patients with breakthrough symptoms of major depressive disorder on antidepressants. J Affect Disord. 2017 Jan 15;208:6-14. doi: 10.1016/j.jad.2016.08.029. Epub 2016 Oct 1. Erratum in: J Affect Disord. 2017 Oct 27;227:198.

6.     The 15th Pacific Rim College of Psychiatrists Scientific Meeting. (https://onlinelibrary.wiley.com/doi/pdf/10.1111/appy.12002)

7.     Pape, W., Wöller, W. Low dose naltrexone in the treatment of dissociative symptoms Nervenarzt 86, 346–351 (2015). https://doi.org/10.1007/s00115-014-4015-9

8.     Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Med. 2009 May-Jun;10(4):663-72. doi: 10.1111/j.1526-4637.2009.00613.x. Epub 2009 Apr 22. PMID: 19453963; PMCID: PMC2891387.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss COVID-19 impact on long term care facilities with Nan Gammill, Executive Director of The Inn at Belden Village.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

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Epilepsy is a broad term used to describe people who suffer multiple seizures in their life time.  Seizures are defined as sudden, uncontrolled electrical brain activity.  Depending on how the brain looks at these electrical currents a person may change behavior, display abnormal movement or even lose consciousness.

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As of 2015 about 3.4 million people suffer from epilepsy.1 Most people with epilepsy take one or more medications to prevent seizure activity. However, an estimated 30% of people worldwide do not respond to current FDA approved medications.2 With the rise in popularity of medical marijuana for treatment of epilepsy, scientists have begun to look at opioids again for new uses.  Ultra-low doses of naltrexone along with morphine or cannabis are being studied.

What is low and ultra-low dose naltrexone?

            Naltrexone is currently FDA approved as treatment for opioid and alcohol abuse. Available in pill or as an injection, treatment for opioid and alcohol abuse uses doses from 50mg to 380mg.  Low dose naltrexone broadly refers to dosages below the 50mg mark for opioid and alcohol abuse treatment.3 specifically 0.5mg to 10mg is the studied range when talking about low dose naltrexone. 

Ultra-low dose refers to even smaller doses ranging from 1/1000000000 of a milligram to 1/1000000 of a milligram. To picture how small ultra-low dose naltrexone is think of opioid treatment doses as a swimming pool.  Low doses are a couple of buckets.  Ultra-low doses would be drops.

There is no recommended dose of naltrexone for epilepsy or seizures in humans. The ultra-low doses have only been studied in mice as add-on to opioids and cannabis products.  These doses were administered in injection form.

How does low dose naltrexone work to prevent seizures?

            Ultra-low doses of naltrexone alone do not stop or prevent seizures.  Morphine and cannabis like products work to raise the amount of electrical activity in the brain needed to cause a seizure.  The exact way ultra-low doses of naltrexone works with opioids and cannabis in epilepsy is unknown.  Scientists think ultra-low naltrexone works either to increase the effects of the morphine and cannabis or helps to decrease tolerance.4-6

What are the studies saying about ultra-low dose naltrexone for epilepsy?

            Trials in mice using ultra-low dose naltrexone have been promising.  Data favors further study of ultra-low dose naltrexone with either opioids or cannabis like products.  However, no data yet suggests any safety for trials in humans.  Further animal study is needed to evaluate long term use.  Current trials in mice only looked at one seizure per mouse.4-6 

What are the risks of using low dose naltrexone for seizure control?

            As stated in the above section, current trial data is only for mice after one incident.  The effects of treatment long term have not been evaluated.  Seizure activity may develop again after time on the medications.  Doses tested in mice may not work in humans.

The Medicine Center Pharmacy in New Philadelphia specializes in custom compounded medications in custom dosage forms. The pharmacists are trained experts in low dose naltrexone therapy. LDN therapies can be customized across 23 different dosage forms for 15 different disease state protocols. If you would like to learn more about low dose naltrexone or would like to schedule a phone call or video conference please contact us.

Resources

1.     CDC [Internet]. Epilepsy Fast Facts. Center for disease control: Atlanta (GA); last updated 18 July 2018, accessed 18 April 2020. Available from: https://www.cdc.gov/epilepsy/about/fast-facts.htm

2.     Wahab A. Difficulties in Treatment and Management of Epilepsy and Challenges in New Drug Development. Pharmaceuticals (Basel). 2010 Jul; 3(7): 2090–2110.Published online 2010 Jul 5. Accessed April 2020.

3.     SAMHSA. Naltrexone. Substance Abuse and Mental Health Services Administration. Last updated  September 2019, accessed April 2020. Available from: https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone

4.     Honar H, Riazi K, Homayoun H, Sadeghipour H, Rashidi N, Ebrahimkhani MR, et al. Ultra-low dose naltrexone potentiates the anticonvulsant effect of low dose morphine on clonic seizures. Neuroscience. 2004;129(3):733-42.

5.     Bahremand A, Shafaroodi H, Ghasemi M, Nasrabady SE, Gholizadeh S, and Dehpour AR. The cannabinoid anticonvulsant effect on pentylenetetrazole-induced seizure is potentiated by ultra-low dose naltrexone in mice. Epilepsy Res. 2008 Sep;81(1):44-51.

6.     Roshanpour M, Ghasemi M, Riazi K, Rafiei-Tabatabaei N, Ghahremani MH, and Dehpour AR. Tolerance to the anticonvulsant effect of morphine in mice: blockage by ultra-low dose naltrexone. Epilepsy Res. 2009 Feb;83(2-3):261-4.